RESUMEN
BACKGROUND: Systemic lupus erythematosus (SLE) may result in great impact on patients' quality of life, social relationships, and work productivity. The use of patient-reported outcome measures (PROMs) in routine care could help capture disease burden to guide SLE management and optimize disease control. We aimed to explore the current situation, appropriateness, and feasibility of PROMs to monitor patients with SLE in routine care, from healthcare professionals' and patients' perspectives. METHODS: A scientific committee developed a Delphi questionnaire, based on a focus group with patients and a literature review, including 22 statements concerning: 1) Use of PROMs in routine care (n = 2); 2) PROMs in SLE management (n = 13); 3) Multidisciplinary management of patients with SLE (n = 4), and 4) Aspects on patient empowerment (n = 3). Statements included in Sects. 2-4 were assessed from three perspectives: current use, appropriateness, and feasibility (with currently available resources). For each statement, panellists specified their level of agreement using a 7-point Likert scale. A consensus was reached when ≥ 70% of the panellists agreed (6,7) or disagreed (1,2) on each statement. RESULTS: Fifty-nine healthcare professionals and 16 patients with SLE participated in the Delphi-rounds. A consensus was reached on the value of PROMs to improve SLE management (83%) and the key role of healthcare professionals (77%) and the need for a digital tool connected to the electronic medical record (85%) to promote and facilitate PROMs collection. PROMs most frequently used in clinical practice are pain (56%), patient's global assessment (44%) and fatigue (39%), all on visual analogue scales. Panellists agreed on the need to implement multidisciplinary consultation (79%), unify complementary tests (88%), incorporate pharmacists into the healthcare team (70%), and develop home medication dispensing and informed telepharmacy programmes (72%) to improve quality of care in patients with SLE. According to panellists, patient associations (82%) and nurses (80%) are critical to educate and train patients on PROMs to enhance patient empowerment. CONCLUSIONS: Although pain, fatigue, and global assessment were identified as the most feasible, PROMs are not widely used in routine care in Spain. The present Delphi consensus can provide a road map for their implementation being key for SLE management.
RESUMEN
PURPOSE: To report the clinical outcomes of two patients implanted with the Raindrop Near Vision Inlay (ReVision Optics, Inc., Lake Forest, CA) to correct for presbyopia and the Visian implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) to correct refractive error. METHODS: Case report. RESULTS: Two patients with presbyopic ametropia complained of blurred vision for distance and near. Both patients received a corneal inlay in the non-dominant eye followed by the Raindrop Inlay the following day. The first patient had an inlay decentration associated with corneal edema and excessive intraocular collamer lens (ICL) vaulting. After ICL exchange and inlay recentration, the ICL stayed properly placed in the ciliary sulcus, and the Raindrop Inlay was well centered. The second patient underwent an uneventful procedure and experienced no complications. At the last visit, both patients were able to see 1.0 (20/20 Snellen) uncorrected visual acuity for distance and near and were satisfied with their vision. CONCLUSIONS: These two cases suggest that the combination of an ICL with a Raindrop Inlay results in good visual outcomes and patient satisfaction. When combining Raindrop Inlay surgery with an intraocular procedure such as Visian ICL implantation, careful lens selection and sizing are required because there may be an increased risk for inlay decentration associated with corneal edema. [J Refract Surg. 2016;32(12):852-854.].
